[e-drug] European conference on antibiotic use

[Kirsten Myhr <myhr@online.no>]

E-drug: European conference on antibiotic use
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Dear E-druggers,

10 days ago the European Union held a conference on antibiotic use in 
Europe. The conference attracted 240 specialists from all over Europe 
(although disappointingly few from Southern Europe) and the lectures as 
well as the workshops were excellent. Below is the press release issued 
after the conference and the Lancet's commentary. All workshop 
recommendations can be found on this address: 
http://esac-www.uia.ac.be/esac/. I think they should be of interest also to 
people outside Europe as they identify determinants of antibiotic use in 
communities and hospitals and recommend interventions and give 
recommendations both to national authorities and the EU.

For clarification: The commercial data referred to are IMS data. The 
project will collect public data using ATC classification and DDDs. The 
Lancet article mentioned is by Cars O et al. Variation in antibiotic use in 
the European Union, in case you want to look it up.

Europe set to act on antibiotic resistance
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----

Most scientists agree that excessive consumption of antibiotics promotes
development of resistance among the microbes that cause infectious 
diseases.
Yet information on consumption of antibiotics across Europe is not freely
available, and the factors that determine differences in antibiotic
consumption are not fully understood. Experts from 33 countries gathered at
the European Conference on Antibiotic Use in Europe (Brussels, Belgium,
November 15-17, 2001) to begin a project that will collect data on
antibiotic use across Europe, and to discuss the determinants of antibiotic
use.

The essential motivation for the Conference is the fear that some common
infections may soon be untreatable if the causative organisms acquire
resistance to all available antibiotics - a scenario that has been called 
the
"post-antibiotic era". Prescription of antibiotics for diseases that are 
not
susceptible to these medicines drives the development of resistance. For
example, patients with upper-respiratory-tract infections are often
prescribed antibiotics by their general practitioner, but these infections
are in most cases caused by viruses, and antibiotics have no effect on
viruses. Normally harmless bacteria that occur in unimaginable numbers in
every part of our environment are exposed to these antibiotics, leading to
the death of most bacteria but also the survival of any organisms that are
naturally resistant. If antibiotic exposure occurs often enough, resistance
may become established in the bacterial population. Prudent use of
antibiotics must become a habit for every doctor.

The Conference was the launch meeting for the European Surveillance of
Antibiotic Consumption (ESAC) project, funded by the European Commission,
which will collect in a standardised manner information on antibiotic use 
in
European Union member states and several other European countries, and make
this information available free of charge. The leader of the ESAC project,
and an organiser of the conference, is Professor Herman Goossens from the
University Hospital Antwerp, Belgium. Some data on antibiotic consumption
are available commercially. These data indicate considerable differences in
the amount of antibiotics used in different European countries. For 
example,
compared with the Nordic countries France, Spain, and Portugal consume 
about
twice as many antibiotics per head of population, yet the people of the
Nordic countries do not seem to suffer because of their modest consumption
of antibiotics. However, these commercial data are expensive and their
method of collection is not made known.

Delegates at the meeting discussed the factors that lead to different
patterns of antibiotic consumption in different countries, and came up with
a series of recommendations for future initiatives and research. These
include development of evidence-based guidelines for appropriate use of
antibiotics, and assessment of the impact of these guidelines and better
patient education on antibiotic use. Delegates also supported the wisdom of
continuing the ban on advertising antibiotics to the public.

The Conference coincides with the adoption by the European Union of a
community strategy against antimicrobial resistance, due to be implemented
by the end of next year. When announcing the strategy, Magda Aelvoet, the
Belgium Minister of Public Health, said that prudent use of antibiotics is
too cautious a term. "What we mean is less use", she added.

Contact: Professor Herman Goossens, Laboratory for Medical Microbiology,
University Hospital Antwerp, Wilrijkstraat 10, B-2650 Edegem-Antwerp,
Belgium.
Tel +32 (3) 821 37 89; fax +32 (3) 825 42 81; e-mail Herman.Goossens@uza.be


Lancet 2001; 358; 1787 (24 November)
European action on antimicrobial resistance

Multinational initiatives to tackle the growing problem of antibiotic
resistance were announced at the European Conference on Antibiotic Use in
Europe (Brussels, Belgium; Nov 15-17). The conference was the launch 
meeting
for the European Surveillance of Antibiotic Consumption (ESAC) project,
funded by the European Commission, which will collect information on
antibiotic use in European Union (EU) member states and several other
European countries.

Available data on antibiotic consumption in Europe must be bought from
commercial sources, which do not reveal their collection methods. An
analysis of commercially available figures (see Lancet 2001; 357: 1851-53)
showed striking differences between countries. For example, compared with
the Netherlands, Denmark, and Sweden, France, Spain, and Portugal use about
twice as many antibiotics per head of population.

Frank Vandenbroucke, Belgium Minister for Social Affairs and Pensions, 
asked
in a speech at the conference: "what is the added value to the quality of
life of using such large amounts of antibiotics?" Little if any, most
experts would agree, but ESAC will hopefully provide the basis for reliable
answers to such questions in a 2-year project that will run until October,
2003.

The cost and volume of antibiotic consumption in community and hospital
settings will be measured at national and regional levels. The ESAC 
database
will also contain information on determinants of antibiotic use, indicators
of good practice, and the strategies used in different countries to control
antibiotic consumption. In addition to the 15 EU member states, 10 
countries
have joined ESAC and collaborators are being sought in additional European
countries (see www.uia.ac.be/esac/).

The EU has recognised that concerted action is necessary to encourage
prudent use of antimicrobials in medicine, and the conference coincided 
with
the adoption by the EU of a strategy against antimicrobial resistance, 
which
is due to be implemented by the end of next year. In announcing the 
strategy
at the meeting, Magda Aelvoet, Belgium Minister of Public Health, said that
prudent use of antibiotics is too cautious a term. "What we mean is less
use", she added.
John McConnell


Kirsten Myhr
Bygdoy alle 58B
0265 Oslo, Norway
Tel +47 22 56 05 85 (h), +47 23 01 64 11 (w), mobil
Faks +47 23 01 64 10
myhr@online.no




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